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* 1. First, tell me a bit about yourself!

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* 2. Please confirm that you understand Amanda does not work with high school or college students in a 1:1 capacity. If you *are* in high school or college, feel free to continue the survey and a member of our team will follow up with available opportunities.

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* 3. Rank in order (high to low priority) what is currently drawing you to explore Anxiety to Empowerment coaching

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* 4. Based off of your response to Q2, please describe what you're looking for in greater detail.

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* 5. What currently triggers your anxiety/self doubt the most?

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* 6. What is currently your biggest blocker, obstacle, or fear point?

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* 7. How do you WANT to feel in the next 6-12 months?

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* 8. Rank your committment to creating change in your life

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* 9. Why do you believe working with a coach is required at this level of your expansion?

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* 10. On a scale of 1 - 10 (with 10 being the MOST ready), how ready are you to invest in your growth?

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i We adjusted the number you entered based on the slider’s scale.

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